Systematic Review and Meta-Analysis With Reconstructed Time-To-Event Data of Frozen Elephant Trunk and Conventional Aortic Repair

Frozen elephant trunk (FET) has gained popularity since its inception. Nevertheless, the optimal approach for managing aortic arch pathologies remains subject of debate. This meta-analysis compared outcomes between patients undergoing FET and those undergoing conventional aortic repair. Systematic searches were conducted up to February 2024. Pooled results of short and long-term outcomes were computed. A systematic review identified 21 non-randomized studies encompassing 3240 patients. Short-term mortality was lower in FET recipients than in those undergoing conventional repair (OR [95% CI] = 0.58 [0.44-0.78], <i>P</i> < .01). Postoperative paraplegia incidence was higher in the FET cohort (OR = 1.85 [1.02-3.34], <i>P</i> = .04), while subgroup analysis showed no difference between the two groups in patients with acute aortic dissection. Long-term all-cause mortality was lower among FET recipients. Subgroup analysis showed FET was associated with reduced all-cause mortality (HR = 0.55 [0.39-0.79], <i>P</i> < .01) and aortic re-intervention (HR = 0.62 [0.39-0.99], <i>P</i> = .05) in acute aortic dissection patients. This meta-analysis underscores the favorable association between the utilization of FET and improved short and long-term outcomes compared with conventional repair, while paraplegia incidence was higher in the FET group. FET appears to offer superior benefits, particularly evident in patients with acute aortic dissection.